{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T18:54:00Z","timestamp":1777056840256,"version":"3.51.4"},"reference-count":72,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2021,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The etiologies of major birth defects are still unclear and few spatial analyses have been conducted in the United States. Spatial analyses of individual\u2010level data can help elucidate environmental and social risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used generalized additive models to analyze 52,955 cases of neural tube defects, congenital heart defects (CHDs), gastroschisis, and orofacial cleft defects, and sampled from 642,399 controls born between 1999 and 2011 in Texas. The effect of geographic location was measured using a bivariable smooth term of geocoded birth address within a logistic regression framework. We calculated and mapped odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects subtypes across Texas, and adjusted for maternal characteristics, environmental indicators, and community\u2010level covariates. We also performed time\u2010stratified spatiotemporal analyses for more prevalent birth defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Location was significantly associated with crude odds of all birth defects except hypoplastic left heart syndrome. After adjusting for maternal characteristics, environmental indicators, and community\u2010level factors, ORs in many geographic areas were no longer statistically significant for most defects, especially CHDs. However, areas of significant and insignificant elevated risk remained for defects in all groups in North and South Texas, with ORs for ventricular septal defects increasing over time. Low risk of birth defects was often present in the northern part of East Texas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Significant spatial patterns of birth defects were identified and varied depending on adjustment of different categories of covariates. Further investigation of areas with increased risks may aid in our understanding of birth defects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1940","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T06:33:45Z","timestamp":1625812425000},"page":"1229-1244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A spatial analysis of birth defects in Texas, 1999\u20132011"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0775-891X","authenticated-orcid":false,"given":"Ian W.","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences University of California  Irvine California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-4963","authenticated-orcid":false,"given":"Peter H.","family":"Langlois","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Human Genetics, and Environmental Sciences University of Texas School of Public Health  Austin Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7153-4606","authenticated-orcid":false,"given":"Ver\u00f3nica M.","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences University of California  Irvine California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Agency for Toxic Substances and Disease Registry. 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